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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock
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Use of a Percutaneous Ventricular Assist Device/Left Atrium to Femoral Artery Bypass System for Cardiogenic Shock

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Implantable cardioverter-defibrillator-related procedures and associated complications in continuous flow left

Ashwin Ravichandran1, Naga Venkata K Pothineni2, Jaimin R Trivedi3

  • 1St. Vincent Heart Center, Indianapolis, Indiana.

Heart Rhythm O2
|January 6, 2022
PubMed

Insights

Procedures for implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) are frequent in left ventricular assist device (LVAD) patients. Continued CRT-D use post-LVAD increases generator changes but does not impact long-term survival.

Area of Science:

  • Cardiology
  • Medical Devices
  • Heart Failure Management

Background:

  • Limited data exist on complication rates for implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy devices (CRT-D) in patients with left ventricular assist devices (LVAD).
  • Understanding these complication rates is crucial for managing patients with advanced heart failure.

Purpose of the Study:

  • To describe the incidence and characteristics of ICD and CRT-D related procedures and complications in a multicenter LVAD cohort.
  • To analyze device type, therapies, procedural complications, and long-term survival in LVAD patients with pre-existing ICDs or CRT-Ds.

Main Methods:

  • A multicenter cohort study included 537 LVAD patients with pre-existing ICD or CRT-D.
  • Data collected included device type, device therapies, procedural complications, and long-term survival.
  • Statistical analysis was performed to compare outcomes between CRT-D and ICD-only groups.

Main Results:

  • Of 537 patients, 280 had CRT-D and 257 had ICD only.
  • Generator replacement was significantly higher in the CRT-D group (28.2% vs 18.3%).
  • Device-related complications occurred in 13% of CRT-D patients and 8% of ICD patients (P = .06), with similar rates of pocket hematoma, infection, and lead malfunction. Post-LVAD antitachycardia pacing for ventricular arrhythmias was higher in the CRT-D group (35% vs 26%).

Conclusions:

  • Cardiac implantable electronic device procedures are common in LVAD patients.
  • Continued CRT-D therapy post-LVAD is associated with significantly more generator changes and a trend towards higher device/lead complications.
  • Device-related complications did not impact long-term survival.
Abstract

Keywords:
Cardiac implantable electronic deviceGenerator changeHeart failureICDLeft ventricular assist deviceProcedures

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